tci General Surgery Coding Alert - 2010 Issue 1

READER QUESTIONS : Clarify ICD-9 Role for Medical Necessity

Question: We are not supposed to bill for an incidental appendectomy, so how would I indicate that the surgeon removed the appendix if I need to account for complications that arise from the appendectomy? Can I bill for the appendectomy CPT code but with $0.00? North Carolina Subscriber Answer: According to CPT, if you wish to report an incidental appendectomy you should use code 44950 (Appendectomy) with modifier 52 (Reduced services). You can assign an appropriate fee based on your own judgment. You should be aware, however, that you do not establish medical necessity using CPT codes. That...

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